BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KAITHAL.

Complaint no.32/14.

Date of instt.: 05.02.2014. 

                                                 Date of Decision: 13.07.2015.

Guddi Devi widow of Ram Mehar S/o Mange Ram, age about 40 years Caste Jat, R/o Village Ram Rai, Tehsil & Distt. Jind.

                                                        ……….Complainant.      

                                        Versus

1.Life Insurance Corporation through its Branch Manager, near Geeta Bhawan, Kaithal.

2. Life Insurance Corporation through its Divisional Manager, Divisional Office, “Jeevan Parkash”, 489, Model Town, Karnal.s

..……..Opposite Parties.

COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.

Before:           Sh. Jagmal Singh, President.

                        Sh. Rajbir Singh, Member.

     Smt. Harisha Mehta, Member.

Present :        Sh. Dalbir Chahal, Advocate for complainant.

Sh. R.P.Bishiyar, Advocate for the opposite parties.

                       ORDER

(JAGMAL SINGH, PRESIDENT).

                       The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that the husband of complainant namely Ram Mehar purchased the “Jeewan Saral” policy for sum of Rs.5,00,000/- from the Ops bearing No.178261125.  It is alleged that on 18.05.2013 the husband of complainant felt breathing problem, when he was at his field, he came to the house and received the medicine from the doctor in the village and soon after he started to feel easy.  It is further alleged that on 20.05.2013 early in the morning, the husband of complainant felt breathing problem and he was provided treatment in the village.  It is further alleged that when the condition was not improved and seemed to be uncontrolled, the husband of complainant was brought to G.H. Jind by the brother of the deceased and got admitted there.  It is further alleged that the doctor of G.H. Jind told the brother of the deceased that there is a deficiency of blood in the body of the husband of complainant and blood transfusion is required to the body of husband of complainant and just after a few time, the transfusion was proceeded to the body of the husband of complainant and during this process at about 11.00., the husband of complainant was breath his last and thus expired.  It is further alleged that the complainant lodged the claim with the Ops and submitted all the necessary documents but the Ops repudiated the claim of complainant vide letter dt. 28.11.2013.  The said repudiation of claim is wrong and illegal.  This way, the Ops are deficient in service.  Hence, this complaint is filed.   

2.     Upon notice, the opposite parties appeared before this forum and filed written statement raising preliminary objections with regard to maintainability; cause of action; locus-standi; jurisdiction; that the complainant has concealed the true and material facts from this Forum.  The actual facts regarding the present complaint are that D.L.A. namely Ram Mehar was not in good health at the time of taking insurance policy and he was suffering from pallor since many months and K/C/O Chronic Renal Failure for the last eight months.  The DLA was admitted to Agroha Hospital, Hisar on 20.05.2013 at 9.00 a.m. vide regd. No.4369 and thereafter admitted to General Hospital, Jind on 20.05.2013 vide OPD No.48694 for his treatment as per form No.3816 issued by the Medical Officer, General Hospital, Jind on 12.09.2013.  The insured has to disclose all the true facts regarding his health at the time of taking policy but he has withheld about his disease in order to get claim falsely by cheating the Ops.  The Ops have conducted the investigation from his official regarding the health of the insured at the time of taking policy.  Thus, the Ops have rightly repudiated the claim application of the applicant after doing the proper investigation about the health of DLA at the time of taking policy.  There is no deficiency in service on the part of answering Ops.  On merits, the contents of complaint are denied and so, prayed for dismissal of complaint.    

3.     In support of their case, both the parties led their evidence in the shape of affidavits and documents.  

4.     We have heard ld. counsel for both the parties and perused the case file carefully and minutely.

5.     We have perused the complaint & reply thereto and also have gone through the evidence led by the parties.

6.     It was argued by ld. Counsel for the complainant that at the time of purchase of “Jeewaj Saral” policy, the husband of complainant was got examined by the Ops through the doctor on their penal.  The medical report was obtained by the said agent Sh. Naresh Kumar and the same was deposited with the Ops along with other documents and only thereafter, the Ops had issued the policy namely “Jeewan Saral” for an amount of Rs.5,00,000/- bearing policy No.178261125 and the husband of complainant had deposited the amount of Rs.12,130/- as the instalment vide receipt No.7033319 dt. 28.03.2013.  He further argued that the deceased namely Ram Mehar was working as a driver in Addarshila Public School, New Bye-pass, Safidon Road, Jind on temporary basis.  In this regard, he placed on record a certificate, Ex.C4 from Addarshila Public School wherein it is mentioned that the deceased Ram Mehar had worked on the post of driver in the said school for the period from 21.04.2012 to 12.03.2013.  He further argued that it is also mentioned in this certificate, Ex.C4 that he was not suffering from any big/serious disease.  He further argued that on 18.05.2013 the husband of complainant Ram Mehar (since deceased) felt breathing problem and on taking the medicines from the doctor in the village, he started to feel easy.  Thereafter on 20.05.2013 in the early morning, he again felt breathing problem and he was taken to General Hospital, Jind by his brother and he was got admitted there.  The doctor of the General Hospital, Jind told that there was deficiency of blood in the body of deceased.  During the treatment there Ram Mehar died at about 11.00 a.m.  He further argued that the Ops have wrongly repudiated the claim of the claimant.  On the other hand, the counsel for the Ops argued that the deceased Ram Mehar was not in a good health at the time of taking the policy and he had not disclosed the true facts about his disease rather suppressed the same deliberately to defraud the Corporation.  He further argued that the Ops had got conducted a confidential enquiry and Ex.R4 is the enquiry report.  He further argued that Ram Mehar was on dialysis for the eight months as is mentioned in the General Hospital, Jind record Ex.R5/Ex.C5.  The deceased Ram Mehar has suppressed these facts at the time of obtaining the policy.  So, his claim was rightly repudiated. 

7.     The complainant has proved on the file that the deceased Ram Mehar had worked as driver in Addarshila Public School, New Bye-pass, Safidon Road, Jind from 21.04.2012 to 12.03.2013 as is clear from Ex.C4.  The school authorities have mentioned in the certificate Ex.C4 that Ram Mehar was all right and was not suffering from any serious disease.  The fact that Ram Mehar was got medically examined by the Ops before the issuance of policy in question has not been denied by the Ops which means that he was medically examined before the issuance of policy.  The contention of the Ops that they have rightly repudiated the claim of the complainant vide Ex.C7.  In Ex.C7, the reason for repudiating the claim is mentioned that In this connection we have to inform you that in the proposal for assurance dated 27.03.2013/Personal statement signed by the deceased Life Assured on 28.03.2013 at the time of his medical examination he had answered the following questions as under:-

11(d)         Q.     Are you suffering from or have you ever suffered from     ailments pertaining to liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System?

Ans.          No

Q.             What has been your usual state of health

Ans.          Good

We may, however, state that all these answers were false as we have evidence and reason to believe that before he proposed for the above policy he had suffered from Pallor & Chronic Renal Failure.  He did not, however, disclose these facts in his proposal form. 

From the facts mentioned above, we found no force in the contention of Ops that the deceased Ram Mehar was not in a good health at the time of the issuance of policy and he had suppressed the true facts and gave wrong facts in the proposal form.  The contention regarding the conduct of confidential enquiry has also no force as the said enquiry report is neither supported by the statements of the persons named in the enquiry namely Suresh Kumar and Har Mohan nor the enquiry report was got signed by them.  Further the above-said enquiry was conducted by the official/officers of the Ops.  The Ops have produced a document i.e. certificate of treatment, Ex.R6 which was issued by Dr. Seema Devi, Medical Officer, General Hospital, Jind in which in clause No.3, it is mentioned that Under whose treatment was the patient before he was admitted into the Hospital?  If the patient had brought a letter or a note from any doctor at the time of admission, Kindly furnish us a certified copy there of.  In reply to this Clause, the doctor mentioned Agroha Hospital, Hisar.  But the Ops have failed to bring any such record that the deceased Ram Mehar had taken treatment from Agroha Hospital, Hisar on the file.  Regarding the mention of dialysis of Ram Mehar in the history by the General Hospital, Jind, the Ops have not placed any document/evidence that the deceased Ram Mehar had got conducted dialysis from any hospital before the issuance of policy in question.  All the documents placed on the file by the Ops are either dated 20.05.2013 or thereafter i.e. after the issuance of the policy which was issued on 28.03.2013.  So, this contention of the Ops that the deceased Ram Mehar was ill before issuing the policy and he gave wrong facts has no force and the same is repelled.  Keeping in view the above facts and circumstances of the case, we are of the considered view that the Ops have wrongly repudiated the claim of complainant and the Ops are deficient in providing services to the complainant.

8.     Thus, in view of above discussion, we allow the complaint and direct the Ops to pay Rs.5,00,000/- as insured amount to the complainant and further to pay Rs.2,000/- as lump sum compensation on account of harassment, mental agony and cost of litigation charges.  Let the order be complied with within one month from the date of communication of this order, failing which, the complainant shall be entitled interest @ 8% p.a. from the date of commencement of this order till its realization.  A copy of this order be sent to both the parties free of cost.  File be consigned to the record room after due compliance.

Announced.

Dt.13.07.2015.

                                                                (Jagmal Singh),

                                                                President.

                (Harisha Mehta),     (Rajbir Singh),       

                        Member.         Member.